Provider Demographics
NPI:1336268804
Name:LUMA, CYNTHIA GRACE (MED, LCPC, LMHC, LMF)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GRACE
Last Name:LUMA
Suffix:
Gender:F
Credentials:MED, LCPC, LMHC, LMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DION AVE
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1119
Mailing Address - Country:US
Mailing Address - Phone:207-439-6600
Mailing Address - Fax:
Practice Address - Street 1:40 DION AVE
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1119
Practice Address - Country:US
Practice Address - Phone:207-439-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2060391041C0700X
MECC2458101YP2500X
MA617106H00000X
MA1621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312294Medicaid